Suicide was defined by the sociologist Emile Durkheim as applying to ‘all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result’. In the UK there are around 5500 recorded suicides every year, and suicide is one of the leading causes of death among young adults. While deliberate self-harm is more common in women, completed suicide is three times more common in men. This may be because men are more likely to use violent and effective methods of suicide, or because men with suicidal thoughts find it more difficult to obtain and engage with the help and support that they need. According to the Office for National Statistics, the population group with the highest suicide rate is men aged from 25 to 44 years old, with a suicide rate of about 18 per 100,000 per year. One major problem with figures such as this one is that they reflect reported suicides, which in turn reflect verdicts reached in coroners’ courts. Actual suicide rates may be considerably higher.

Demographic risk factors for suicide
At the individual level, a person’s risk of committing suicide can be increased by a number of demographic and social risk factors. Demographic risk factors for suicide include being male; being relatively young; and being single, widowed, or separated or divorced. Certain occupational groups such as veterinary surgeons, farmers, pharmacists, and doctors have been found to be at a higher risk of suicide. This is probably to do with their training and skills, and with their easy access to effective means of committing suicide, such as prescription-only drugs and firearms. Social risk factors for suicide include being unemployed, insecurely employed, or retired; having a poor level of social support as is often the case for the elderly, prisoners, immigrants, refugees, and the bereaved; and having been through a recent life crisis such as losing a close friend or relative or being the victim of physical or sexual abuse.

Clinical risk factors for suicide
As well as demographic and social risk factors, a person’s risk of committing suicide can also be increased by a number of clinical risk factors. The most important predictor of suicide is a previous act of deliberate self-harm, and a person’s risk of completing suicide in the year following an act of deliberate self-harm is approximately 100 times greater than that of the average person. Conversely, up to half of all people who complete suicide have a history of deliberate self-harm. Suicidal behavior tends to cluster in families, so a family history of deliberate self-harm also increases a person’s risk of suicide. This is perhaps because suicide is a learned behaviour or, more likely, because family members share a generic predisposition to psychiatric disorders that increase suicidal risk, such as schizophrenia, depression, bipolar disorder, personality disorders, and alcohol dependence. Some of these psychiatric disorders, for example, personality disorder and alcohol dependence or schizophrenia and depression may, and often do, coexist. People with a psychiatric disorder who are resistant to their prescribed medication or non-compliant with it are also at a higher risk of suicide, as are people experiencing certain specific symptoms such as delusions of persecution, delusions of control, delusions of jealousy, delusions of guilt, commanding second person auditory hallucinations (for example, a voice saying ‘Take that knife and kill yourself’), and passivity which is the feeling that one’s feelings, desires, and actions are under the control of an external agency. Physical illness can also increase the risk of suicide, and this is particularly the case for physical illnesses that are terminal, that involve chronic pain or disability, or that affect the brain. Examples of such physical illnesses include cancer, early-onset diabetes, stroke, epilepsy, multiple sclerosis, and AIDS.

Fighting suicidal thoughts
If you are assailed by suicidal thoughts, the first thing to remember is that many people who have attempted suicide and survived ultimately feel relieved that they did not end their lives. At the time of attempting suicide they experienced intense feelings of despair and hopelessness, because it seemed to them that they had lost control over their lives, and that things could never get better. The only thing that they still had some control over was whether they lived or died, and so committing suicide seemed like the only option left. This is never true.

Some of the thoughts that may accompany suicidal thoughts include:
– I want to escape my suffering.
– I have no other options.
– I am a horrible person and do not deserve to live.
– I have betrayed my loved ones.
– My loved ones would be better off without me.
– I want my loved ones to know how bad I am feeling.
– I want my loved ones to know how bad they have made me feel.

Whatever thoughts you are having, and however bad you are feeling, remember that you have not always felt this way, and that you will not always feel this way.

The risk of someone committing suicide is highest in the combined presence of (1) suicidal thoughts, (2) the means to commit suicide, and (3) the opportunity to commit suicide. If you are prone to suicidal thoughts, ensure that the means to commit suicide have been removed. For example, give tablets and sharp objects to someone for safekeeping, or put them in a locked or otherwise inaccessible place. At the same time, ensure that the opportunity to commit suicide is lacking. The surest way of doing this is by remaining in close contact with one or more people, for example, by inviting them to stay with you. Share your thoughts and feelings with these people, and don’t be reluctant to let them help you. If no one is available or no one seems suitable, there are a number of emergency telephone lines that you can ring at any time. You can even ring 999 for an ambulance or take yourself to an Accident and Emergency department. Do not use alcohol or drugs as these can make your behavior more impulsive, and significantly increase your likelihood of attempting suicide. In particular, do not drink or take drugs alone, or end up alone after drinking or taking drugs.

Make a list of all the positive things about yourself and a list of all the positive things about your life, including the things that have so far prevented you from committing suicide (you may need to get help with this). Keep the lists on you, and read them to yourself each time you are assailed by suicidal thoughts. On a separate sheet of paper, write a safety plan for the times when you feel like acting on your suicidal thoughts. Your safety plan could involve delaying any suicidal attempt by at least 48 hours, and then talking to someone about your thoughts and feelings as soon as possible. Discuss your safety plan with your GP, psychiatrist, or key worker and commit yourself to it. See Figure 19.1 for an example of a safety plan. Sometimes even a single good night’s sleep can significantly alter your outlook, and it is important not to underestimate the importance of sleep. If you are having trouble sleeping, speak to a doctor.

Example of a safety plan
1. Read through the list of positive things about myself.
2. Read through the list of positive things about my life and remind myself of the things that have so far prevented me from committing suicide.
3. Distract myself from suicidal thoughts by reading a book, listening to classical music, or watching my favourite film or comedy.
4. Get a good night’s sleep. Take a sleeping tablet if necessary.
5. Delay any suicidal attempt by at least 48 hours.
6. Call Stan on (phone number). If he is unreachable, call Julia on (phone number). Alternatively, call my key worker on (phone number), or the crisis line on (phone number).
7. Go to a place where I feel safe such as the community centre or the sports centre.
8. Go to the Accident and Emergency Department.
9. Dial 999 for an ambulance.

Once things are a bit more settled, it is important that you address the cause or causes of your suicidal thoughts in as far as possible, for example, a mental disorder such as depression or alcohol dependence, a difficult life situation, or painful memories. Discuss this with your GP or another healthcare professional, who will help you to identify the most appropriate form of help available.